Medical Science- Dermatology Part 1

Data to during Physical Exam (PE)

-new vs. change in existing lesion

-Timeline: acute vs. gradual

-skin specific vs. underlying disease

-location

-associated symptoms

-how is patient affected (embarrassed, painful, ect.)

-new exposures (change in soap, detergent, contact with environmental)

-medications

-contact with other people with similar symptoms

-past history of same symptoms

Patient- related data

-allergies

-history of chronic skin conditions or suspicious lesions

-chronic illness

immunization status

-past procedures or biopsies

-practice of self-exams

-previous total body examination

-family history (autoimmune disorders, cancer, atopic disorders)

Psychosocial components

-occupation

-sports

-skin routine

-substance use

-stress

-hygiene (hair/nail treatments)

Skin cancer risk factors

-age 50+

-fair, freckled, ruddy complexion (fitzpatrick 1-2)

-light colored eyes

-easily sunburned

-location of living

-exposure to chemicals

-precancer skin conditions

Types of Skin Exams

-Total Body

-Problem focused

-general screening/integrates

magnification with hand lens

to see lesion close up

Wood lamp

black light used to look for fungus

Diascopy

process on put pressure on lesion to see is blanchable (discoloration when pressure applied= vascular)

blanchable= vascular or not

Dermoscopy

handheld lens with built-in light

non-invasive (can see deeper layer of epidermis and beyond)

Describing lesions

Morphology:

-size

-shape

-border

-texture

color

arrangment

associated manifestations

KOH prep

after sample is taken KOH 9potassium hydroxide) is added to slide to remove skin cells but leave behind fungal cells

fungul cultures

grow to see but cultures from sample is growing

Tzank Smear

scraping a blister/ ulcer for samples

Skin scraping

scraping a lesion to have it examined under a microscope

Skin patch testing

test for allergies on labeled areas of skin

Pattern Recognition Diagnosis Method

morphology of primary lesion

location

configuration (arrangement of lesions)

Analytic Diagnosis Method

-evaluation of history

-physical exam

-testing

-results from diagnostic tests

Vehicle of treatment

powder, foam, solution, gel, lotion, cream, ointment, oral

Ointment clinical use

dry, thick, lichenified, or fissured lesions

petrolleum jelly base (80% oil)

Cream

hot, humid climate or intertriginous skin

50% water, 50% oil

lotion

over the counter and prescriptions moisturizers and sunscreens

more watery than cream, low viscosity

gel

best for facial and hair-bearing areas

liquifies on skin

minimum residue, drying, shiny

solution

scalp conditions

base of water or alchol, very drying

foam

hair-bearing areas

drying, leaves mineral residue

powder

body-fold areas and feet

drrying and decreases frictions

Steroids

anti-inflammatory, anti-proliferation, immunosupprive

wide variety of uses in dermatology

potency ranked form (1 super potent to 7 least potent)

can cause skin atrophy, striae (strechmarks), hypopigmentation, delayed wound healing, allergic/contanct dermitities

antifungal

kills fungus infections

Emollient

moisturizer

derm topical selection rule

if it’s dry, wet it, it’s wet, dry it

calcineurin inhibitors

non-steroidal inhibitor, immunosuppressants (2nd line of defense for atopic dermatitis

surgical procedures

◦Excision

◦Incision & Drainage

◦Cryotherapy (freeze off lesion)

◦Laser therapy (burn off lesion)

Photodynamic therapy (help reserve skin damage)

scar revision

Treatment for pruritis

anit-pruritic medications

lotions containing calamine, camphor, methol, or pramoxine, sarna

cosmetic procedures

§  Botox Injections

§  Dermal Filler Injections

§  Laser Hair Removal

§  Laser Photo-Rejuvenation

·      Help with wrinkles and skin damage

§  Microdermabrasion

§  Chemical Peels

hair follicle

tube shaped slot where hair fiber sits

hair fiber components

medulla (middle), cortex (next layer after medulla), and cuticle (outside sleeve of hair)

terminal hair

hair on head

vellus

peach-fuzz on skin

Anagen phase

hair grows thick

catagen phase

hair roots (follicle) begins to degerate

telogen phase

hair growth stops completely

Early anagen

old hair falls out, new hair grows

Alopecia

hairloss

focal hair loss

patchy

diffuse hair loss

thins out evenly

Patterned hair loss

progressive, symmetric hair los

Alopecia Areata

chronic immune disorder that targets hair follicles

3 patterns;

patchy= oval shaped areas of hair loss

alopecia totalis= complete hair loss on scalp

alopecia universalis= complete hairloss across body

nonscarring!!!

clinical diagnostic

Cicatrical (scarring) Hair Loss

irreversible hair follicle destruction secondary to root sheath

Alopecia Areata Treatment

counseling

corticosteriod (intralesional) or topical

topical immunotherapy

laster therapy

topical mixoxidil

cosmetic coverages (wigs and hair pieces)

Trichorrhexis Nodosa

hair breakage due to trauma (tight hairstyles), heat application, excessive brushing, chemical trauma (hair colorants and bleaches)

Androgenic Alopecia (male)

Androgen (sex hormones)= overproduced dihydrotestosterone

happens as men age

decreased in terminal (head, facial, body) hair density

MINIATURIZATION of hair follicle (orifice may only be a lil visible)

PATTERNED HAIR LOSS (reciting hairline, bald patch, top of head

NONSCARRING

Androgenic Alopecia (men) treatment

1st = finasteride (blocks conversion of testosterone into dihydrotestosterone) and topical minoxidil (encouragers proliferation of hair follicle cells)

2nd= surgical hair transplant

or cosmetic options

Androgenic Alopecia (female)

Follicular miniaturization

decrease in ration of terminal hairs to thinner vellus hairs

presentation= hair thinning/ reduction in density

NONSCARRING

Treatment of Androgenic Alopecia (female)

1st) topical minoxidil

2nd) oral agents that inhibit androgenic production (in women with known androgenic component)

surgical hair transplant

low level laser hair therapy

cosmetic options

Trichotillomania

an impulse control disorder

can be associated with anxiety and obsessive- compulsive disorders

hair is manually pulled out

presentation= bald patches, loss of eyebrows or eyelashes

Treatment of Tricotillomania

Pysch referal

SSRI’s can be used to manage anxiety disorders

Telogen Effluvium

When large number of hairs enter telogen phase and fall out (3-5 months after) emotional or stressful event

Presentation= uniform hair loss, male and female the same

treatment= self resolving

Anagen Effluvium

Presentation= Abrupt, abnormal diffuse of hair loss

causes metabolic and mitotic activity of hair follicle in inhibited from chemotherapy and other medications

Treatment: Reversible after 1-3 months of cessation of offending agent

Beau lines

horizontal lines of nails

causation= severe illness, high fever, chemotherapy (any inteerpt to nail growth)

longitudinal grooves on nails

caused by subungual glomus tumur (nailbed tumor)

nail pitting

focal area of nail with abnormal kertiniauation of nail matrix

seen with psoriasis, alopecia areata, atopic dermatitis

Leukonychia

white discoloration of the nails

melanonychia

brown/black discoloration of the nail

erythronychia

pink/red discoloration of the nial

Onychomycosis

fungal infection found mostly on toenails

named based on location of infection of nail-bed

o   Distal/Lateral

o   Proximal

o   Superficial

o   Total Dystrophic

Presentation= white-yellow nail discoloration, thickened, irregular nail with erosion at tip, excessive keratinaceous growth underneath nail plate

Acute Paronychia

presentation= longitudinal side of nail

rapid onset of erythema, edema, and tenderness at proximal nail fold, later fills with puss

causation= strep or staph species (risk from manicures, nail biting, thumb-sucking, trauma, in growth nails

treatment= antibiotics and incision and drainage

nail clubbing

presentation thickening of nail bed’s soft tissue, particularly in the proximal end, usually affects all fingernails

Schamroth sign

absence of normal diamond shape when you put nails together, nails, will curve out from one another

Lovibond

angle of nail should be 180, but in a lovibond case, the angle is greater than 180

Splinter Hemorrhages

under nail plate

appearance= red/black, thin, longitudinal

causation, trauma, chronic renal failure, psoriasis, infective endocarditis